Correlation of anxiety and depression with mindfulness in esophageal cancer patients undergoing esophagectomy and analysis of risk factors

BACKGROUND Anxiety complicates recovery in esophagectomy patients undergoing esophagectomy, while preoperative depressive symptoms may further delay surgery-associated malnutrition resolution, highlighting a critical need for psychological intervention. AIM To explore the correlation of anxiety and depression with mindfulness levels in patients undergoing esophagectomy for esophageal cancer and analyze associated risk factors. METHODS A total of 120 patients with esophageal cancer, all of whom underwent esophagectomy in The Affiliated Yongchuan Hospital of Chongqing Medical University between September 2022 and September 2024, were enrolled. The hospital anxiety and depression scale (HADS) was utilized to evaluate the anxiety (HADS-anxiety subscale, HADS-A) and depression (HADS-depression subscale, HADS-D) levels of these patients, and the Mindful Attention Awareness Scale (MAAS) was employed to assess their mindfulness levels. The relationships among anxiety, depression, and mindfulness levels were analyzed, and both univariate and multivariate analyses were conducted to identify the risk factors for anxiety and depression in these patients. RESULTS Data revealed that the mean HADS-A score of patients undergoing esophagectomy was (10.43 ± 4.24) points, and 40.00%, 35.00%, and 10.83% of the patients had mild, moderate, and severe anxiety, respectively. The mean HADS-D score was (9.20 ± 4.66) points, and 37.50%, 23.33%, and 9.17% of the patients had mild, moderate, and severe depression, respectively. Patients with negative or mild anxiety (or depression) exhibited significantly higher MAAS scores than those with moderate or severe anxiety (or depression). The HADS-A and HADS-D scores showed a strong and negative correlation with the MAAS score. Univariate and multivariate analyses demonstrated that sex (P = 0.006), age (P = 0.017), per capita monthly household income (P = 0.005), and educational level (P = 0.004) were all independently associated with the exacerbation of anxiety in patients undergoing esophagectomy. Age (P = 0.026), living status (P = 0.005), per capita monthly household income (P = 0.024), educational level (P = 0.002), and postoperative complications (P < 0.001) were all independently related to the aggravation of depression in such patients. CONCLUSION This study indicated a significant negative correlation among anxiety, depression, and mindfulness levels in patients undergoing esophagectomy. Sex, age, per capita monthly household income, and educational level were risk factors for anxiety in patients undergoing esophagectomy, whereas age, living status, per capita monthly household income, educational level, and postoperative complications were risk factors for depression.